MEDICARE: ANTHONY SURACE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	000076	NY

General Provider Information

NPI Number	:	1790228021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY SURACE

Provider Business Mailing Address
First Line	:	3107 STONY POINT RD
Second Line	:
City	:	GRAND ISLAND
State	:	NY
Zip	:	14072-1170
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3107 STONY POINT RD
Second Line	:
City	:	GRAND ISLAND
State	:	NY
Zip	:	14072-1170
Country	:	US
Telephone Number	:	716-773-2606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2016
Last Update Date	:	11/17/2016

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Directions to “ ANTHONY SURACE ” Practice Location

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